| NPI | 1356945182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK BANCROFT VYE VP Of Administration 860-972-7858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| 213E00000X Podiatrist | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2020-11-23 |
| Last Update Date | 2020-11-23 |